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The Social Norms Approach The Social Norms Approach Scott Crosby Health & Wellbeing Programme Manger Public Health England Leeds Institute of Health Sciences Division of Psychiatry and Behavioural Sciences Acknowledgment Dr Bridgette M Bewick, Associate Professor in Psychological Health and Wellbeing Leeds Institute of Health Sciences Can beliefs about what others think and do change our behaviour? The Asch Experiment (Asch, 1952) During the 1950s Solomon Asch conducted and published a series of experiments that demonstrated the degree to which an individual's own opinions are influenced by those of a majority group here 1950 TV commercial from Camel cigarettes What is the overall aim of the social norms approach? • The overall aim is to correct misperceptions that people may have about a health behaviour. • Studies have found that by correcting misperceptions, it can lead to more healthy behaviour, i.e. shifting the focus from targeting the individual (people at risk of smoking) to the environment (people living in risky environment in which smoking is the norm) is key to strengthening norms. What Influences people’s health Seeking to understand and influence behaviour by addressing personal factors alone, is unlikely to work, because it fails to take into account the complex and interrelated nature of the factors that influence what we do. We do not act in isolation, and most people are influenced to a very great extent by the people around them Social Norms Essentially, the social norms approach uses a variety of methods to correct negative misperceptions (usually overestimations of use), and to identify, model, and promote the healthy, protective behaviours that are the actual norm in a given population. When properly conducted, it is an evidence-based, data-driven process, and a very cost-effective method of achieving large-scale positive results. How Do Misperceptions Occur? • We notice the “difference” not the pattern. “Out of the Ordinary” gets the attention. • Focusing on the unusual makes it appear usual. • Not-normal behaviour looks like the Norm. What Stands Out? What message is this sending? Now what? • We care so much we want to “scare the health into them”. • Unfortunately, we inadvertently NORMALISE the very behaviour we are trying to decrease. • Fear in ads keeps us in the past (fearful experience) or worried about the future (potential fearful experience). • It does not allow us to be in the present moment. How does the social norm approach differ from traditional approaches? The social norms approach • does not use ‘hard hitting scare tactics’ • uses credible science based statistics • focuses on healthy behaviours and attitudes; doesn’t show smoking or cigarettes • does not use negative images; uses only positive visuals • involves the local community from the very beginning • not draconian or directive, but instead uses a simple format to present information about healthy social norms back to the community Social Norms Approach To address misperceptions of the norm Social Marketing Social Norms Normative message Engaging photo of student in a familiar location Image shows ‘positive’ behaviour Recognisable logo Data source Leeds Institute of Health Sciences Division of Psychological and Social Medicine Preparation Data collection Data analysis at baseline Intervention Follow-up Evaluation Leeds Institute of Health Sciences Division of Psychological and Social Medicine Preparation Data collection Data analysis at baseline Intervention Follow-up Evaluation Leeds Institute of Health Sciences Division of Psychological and Social Medicine Social Norms Approach Leeds Institute of Health Sciences Division of Psychological and Social Medicine Visit the NSNC website for a short overview of the social norms approach. Leeds Institute of Health Sciences Division of Psychological and Social Medicine Behaviour question and corresponding perception question Leeds Institute of Health Sciences Division of Psychological and Social Medicine Behaviour question and corresponding perception question Leeds Institute of Health Scienceshttp://social-norms.org.uk/project/what-the-flock/ Division of Psychiatry and Behavioural Sciences Could the social norms approach be used in other UK organisations? Leeds Institute of Health Sciences Division of Psychological and Social Medicine http://social-norms.org.uk/project/pinderfields-hospital/ (0.00 to 0.55 mins) Leeds Institute of Health Sciences Division of Psychological and Social Medicine Is it possible to implement a social norms approach in a UK community setting? Bewick et al. (2013) Leeds Institute of Health Sciences Division of Psychiatry and Behavioural Sciences How do you take forward a social norms approach? The most cost effective way of demoralising a behaviour is to focus locally at the grassroots level utilising assets within the community. Taking a bottom-up approach ensures that the norm is embedded for sustainability. Major steps include: 1. Collecting baseline data on attitudes and behaviour. 2. Analysing the data, identifying patterns of actual behaviour, attitudes and perceived norms. 3. Developing a campaign promoting the positive social norms messages that were identified. Identify communication channels to disseminate campaign. 4. Evaluating impact on attitudes and behaviour, plan ongoing actions http://social-norms.org.uk/ Summary The social norms approach to behaviour change combines lessons learned from a variety of fields including social marketing, sociology, behavioural psychology and evaluation research. Our perceptions of our peers’ attitudes and behaviours have a great influence on our own attitudes and behaviours. • Unfortunately, our perceptions are often inaccurate: We tend to over- estimate the number of our peers who value and make unhealthy choices and under-estimate the number who value and make healthy choices. • If, in a given group or population of people, most people are making healthy choices but most people believe that their peers are making unhealthy choices, then a social norms approach may reduce the misperception and further encourage healthy choices. Important Lessons The social norms approach focuses on positive messages about healthy behaviours and attitudes that are common to most people in a group: • It does not use scare tactics or stigmatise an unhealthy behaviour. • It avoids moralistic messages from authorities about how the target group “should” behave. Instead, it simply presents the healthy norms already existing in the group. • It builds on the assets already in the community, through participation by community members, and by highlighting those who make healthy choices. Important lessons Some important lessons learned in the course of several decades of research include: • The effectiveness of social norms marketing interventions can be undermined if the overall environment supports and promotes unhealthy choices. • The effectiveness of Social Norms Approach interventions can be enhanced if the norms that are promoted reflect a group that the individuals closely identify with. • Social norms approach's are perhaps best conceptualized as culture change interventions, taking more than one year to realise the behavioural change effects. Leeds Institute of Health Sciences Division of Psychological and Social Medicine References and further reading Asch, S.E. (1952). Social Psychology. New York, Prentice Hall. Bewick, B.M., Bell, D., Crosby, S., Edline, B., Keenan, S., Marshall, K. and Savva, G. (2013). Promoting improvements in public health: Using a Social Norms Approach to reduce use of alcohol, tobacco, and other drugs. Drugs: Education, Prevention and Policy, 20(4):322-330. Bewick, B.M., Trusler, K., Barkham, M., Hill, A.J., Cahill, J. and Mulhern, B. (2008). The effectiveness of web- based interventions designed to decrease alcohol consumption – a systematic review. Preventive Medicine, Doi:10.1016/j.ypmed.2008.01.005. Bewick, B.M, Mulhern, B., Barkham, M., Trusler, K., Hill, A.J. and Stiles, W.B. (2008). Changes in undergraduate student alcohol consumption as they progress through university. BMC Public Health, 8, 163, Doi:10.1186/1471-2458-8-163. Bewick, B.M., West, R.M., Gill, J., O’May, F., Mulhern, B., Barkham, M. and Hill, A.J. (2010). Providing web- based feedback and social norms information to reduce student alcohol intake: a multi-site investigation. Journal of Medical Internet Research. Bewick, B.M., West, R.M., Bakrham, M., Mulhern, B., Marlow, R., Traviss, G. and Hill, A.J. (2013). The effectiveness of a web-based personalised feedback and social norms alcohol intervention on United Kingdom university students: Randomized Controlled Trial. Journal of Medical Internet Research, 15(7): e137 Leeds Institute of Health Sciences Division of Psychological and Social Medicine Bewick, B.M. Trusler, K., Mulhern, B., Barkham, M. and Hill, A.J. (2008). Feasibility and effectiveness of a web-based personalized feedback and social norms alcohol intervention in UK university students: a randomized control trial. Addictive Behaviors, Doi:10.1016/j.addbeh.2008.05.002. McAlaney, J., Bewick, B.M., Hughes, C. (2010). The international development of the ‘Social Norms’ approach to drug education and prevention. Drugs: Education, Prevention and Policy. Moreira M.T., Smith L.A,. Foxcroft D. (2009). Social norms interventions to reduce alcohol misuse in University or College students (Review) The Cochrane Collaboration. JohnWiley & Sons, Ltd. Montana, C. and Bewick, B. (2009) Student substance use and well-being: Results of an online audit commissioned by Leeds Student Substance Use and Mental Health Group. Internal report prepared by University of Leeds, UK..
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